Thyroid nodules: a review of current guidelines, practices, and prospects

Abstract

In 2006, two major society-sponsored guidelines and one major consensus statement for thyroid diagnosis and management were published by: the American Association of Clinical Endocrinologists/Associazione Medici Endocrinologi (AACE/AME); the American Thyroid Association (ATA); and the European Thyroid Association (ETA). A careful review of these guidelines reveals that despite many similarities, significant differences are also present, likely reflecting differences in practice patterns, interpretation of existing data, and availability of resources in different regions. The methodology of the guidelines is similar, but a few differences in the rating scale make a rapid comparison of the strength of both evidence and recommendations difficult for the use in current clinical practice. Some recommendations are based mostly on experts' opinion. Thus, a same recommendation may be based on a different evidence; on the other hand, sometimes the same evidence may induce a different recommendation. Therefore, efforts are needed to produce a few high-quality clinical studies to close the evidence gaps in the still controversial fields of thyroid disease and to create a joint task force of the most authoritative societies in the field of thyroid disease in order to reach a common document for clinical practice recommendations. European Journal of Endocrinology 159 493-505

Malignant and benign thyroid nodules after total body irradiation preceding hematopoietic cell transplantation during childhood

“…This prevalence increases with age, particularly during puberty and adulthood, reaching about 20% in midlife in countries with no marked iodine deficiency (30,33). Thyroid nodules are less common in children than in adults, but the risk of malignancy is much higher in children, with an estimation of 10-25% of thyroid nodules being malignant vs only 5% in adults.…”

Risk of malignancy in the non-dominant thyroid nodule

“…The ATA guidelines suggest that thyroid ultrasound should be performed in all patients with one or more suspected thyroid nodules. The ETA guidelines state that thyroid ultrasound is mandatory when a nodule is discovered at palpation [10]. Recently, the considerable controversy over whether clinically unapparent thyroid nodules should be assessed by FNA has not reached to a conclusion [11].…”

Management of Thyroid Nodules

“…Only 1 in 20 clinically detected thyroid nodules are malignant [2][3][4][5][6][7][8][9][10][11]. Several risk factors for malignant nodule have been identified (Table 1).…”